scholarly journals Evaluating discharges and readmissions using a COVID Virtual Ward model: a retrospective data study assessing patient outcomes and the likely staffing commitment

2021 ◽  
Author(s):  
Suzy Gallier ◽  
Catherine Atkin ◽  
Vinay Reddy-Kolanu ◽  
Dhruv Parekh ◽  
Xiaoxu Zou ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Observational Studies ◽  
Care Pathway ◽  
Early Discharge ◽  
Acute Medical Unit ◽  
Phone Calls ◽  
Routinely Collected Health Data ◽  
Acute Hospitals ◽  
Using Data ◽  
Pulse Oximeters

Background: COVID-19 has placed a catastrophic burden on acute hospitals. In an attempt to reduce admissions and enable safe early discharge, a COVID virtual ward (CVW) care pathway has been supported by NHS England. This includes discharging people who meet objective criteria based on acuity scores and oxygen saturations, with pulse oximeters and daily phone calls for up to 14 days. Observational studies have reported the safety of this system, but without describing the outcomes from usual care. Methods: A retrospective study using routinely collected health data from all adults with a confirmed positive severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) swab result between 1st June 2020 and 31st Jan 2021 who attended the Emergency Department or Acute Medical Unit at QEHB, which does not have a CVW service. Criteria for CVW were applied using data from the first 24 hours of presentation to hospital and subsequent health outcomes were included for 28 days, including re-presentation, re-admission, ITU escalation and death. Results were compared to reported studies based in secondary care. Results: During the study period, 26,127 patients presented to QEHB hospital. 2301 had a positive SARS-CoV-2 swab. Of these, 1730 (75.2%) did not meet the criteria for the CVW and 571 (24.8%) did. Of the 571, 325 (56.9%) were discharged home within 24 hours and 246 (43.1%) were admitted for 24 hours or longer. Those admitted were older, with increased co-morbidities, 80.9% required hospital-supported acute therapies after the first 24 hours and 10.6% died. Of the 325 discharged, 44 were readmitted (13.5%), 30 (9.2%) with COVID-related symptoms, 5 (1.5%) required ITU and 1 patient (0.3%) died. These results were comparable to published studies with a CVW service. Discussion: In the current study, discharging patients without a CVW did not confer a greater risk of re-presentation, re-admission, ITU escalation or death. The majority of patients who remained in hospital despite meeting the CVW criteria did so for the provision of treatments or acute assessments. It remains uncertain whether a CVW delivers improvements in hard outcomes, and further research is needed.

Acute hospitals and older people in Australia

2002 ◽  
Vol 22 (5) ◽  
pp. 637-646 ◽  
Author(s):  
JOHN MCCORMACK
Keyword(s):  
Older People ◽  
Early Discharge ◽  
Service Levels ◽  
Levels Of Care ◽  
Australian Health ◽  
Policy Responses ◽  
Acute Hospitals ◽  
Set Up ◽  
Financial Burdens ◽  
Management Groups

The Australian health care system is frequently portrayed as being in crisis, with reference to either large financial burdens in the form of hospital deficits, or declining service levels. Older people, characterised as a homogeneous category, are repeatedly identified as a major contributor to the crisis, by unnecessarily occupying acute beds while they await a vacancy in a residential facility. Several enquiries and hospital taskforce management groups have been set up to tackle the problem. This article reviews their findings and strategic recommendations, particularly as they relate to older people. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care, and which, while claiming positive intentions, may introduce new forms of age discrimination into the health system. Few of the currently favoured proposals promote age-inclusivity and older people's rights to equal access to acute care.

EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Benjamin Clayphan ◽  
Anna Fairclough ◽  
Jeff Lim ◽  
Roderick Alexander
Keyword(s):  
Ct Scan ◽  
Patient Outcomes ◽  
Bowel Obstruction ◽  
Care Pathway ◽  
Imaging Modality ◽  
Ct Scans ◽  
Abdominal Ct ◽  
Retrospective Audit ◽  
Raising Awareness ◽  
Time To Diagnosis

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO.   Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation.  Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr.  Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes. 

scholarly journals Characterization and selection of Japanese electronic health record databases used as data sources for non-interventional observational studies

2021 ◽  
Author(s):  
Yumi Wakabayashi ◽  
Masamitsu Eitoku ◽  
Narufumi Suganuma
Keyword(s):  
Electronic Health Record ◽  
Observational Studies ◽  
Large Scale ◽  
Data Sources ◽  
Flow Diagram ◽  
Health Record ◽  
Medical Institutions ◽  
Data Source ◽  
Electronic Health ◽  
Using Data

Abstract Background Interventional studies are the fundamental method for obtaining answers to clinical question. However, these studies are sometimes difficult to conduct because of insufficient financial or human resources or the rarity of the disease in question. One means of addressing these issues is to conduct a non-interventional observational study using electronic health record (EHR) databases as the data source, although how best to evaluate the suitability of an EHR database when planning a study remains to be clarified. The aim of the present study is to identify and characterize the data sources that have been used for conducting non-interventional observational studies in Japan and propose a flow diagram to help researchers determine the most appropriate EHR database for their study goals. Methods We compiled a list of published articles reporting observational studies conducted in Japan by searching PubMed for relevant articles published in the last 3 years and by searching database providers’ publication lists related to studies using their databases. For each article, we reviewed the abstract and/or full text to obtain information about data source, target disease or therapeutic area, number of patients, and study design (prospective or retrospective). We then characterized the identified EHR databases. Results In Japan, non-interventional observational studies have been mostly conducted using data stored locally at individual medical institutions (713/1463) or collected from several collaborating medical institutions (351/1463). Whereas the studies conducted with large-scale integrated databases (195/1463) were mostly retrospective (68.2%), 27.2% of the single-center studies, 46.2% of the multi-center studies, and 74.4% of the post-marketing surveillance studies, identified in the present study, were conducted prospectively. Conclusions Our analysis revealed that the non-interventional observational studies were conducted using data stored local at individual medical institutions or collected from collaborating medical institutions in Japan. Disease registries, disease databases, and large-scale databases would enable researchers to conduct studies with large sample sizes to provide robust data from which strong inferences could be drawn. Using our flow diagram, researchers planning non-interventional observational studies should consider the strengths and limitations of each available database and choose the most appropriate one for their study goals. Trial registration Not applicable.

scholarly journals A Mixed-Methods Approach to Synthesizing Evidence on Mediators of Intervention Effects

2011 ◽  
Vol 33 (7) ◽  
pp. 870-900 ◽  
Author(s):  
Jennifer Leeman ◽  
YunKyung Chang ◽  
Corrine I. Voils ◽  
Jamie L. Crandell ◽  
Margarete Sandelowski
Keyword(s):  
Mixed Methods ◽  
Systematic Reviews ◽  
Behavioral Change ◽  
Observational Studies ◽  
Intervention Studies ◽  
Meta Analysis ◽  
Intervention Effects ◽  
Mediation Effects ◽  
Mixed Methods Approach ◽  
Using Data

Greater understanding of the mechanisms (mediators) by which behavioral-change interventions work is critical to developing theory and refining interventions. Although systematic reviews have been advocated as a method for exploring mediators, this is rarely done. One challenge is that intervention researchers typically test only two paths of the mediational model: the effect of the intervention on mediators and on outcomes. The authors addressed this challenge by drawing information not only from intervention studies but also from observational studies that provide data on associations between potential mediators and outcomes. They also reviewed qualitative studies of participants’ perceptions of why and how interventions worked. Using data from intervention ( n = 37) and quantitative observational studies ( n = 55), the authors conducted a meta-analysis of the mediation effects of eight variables. Qualitative findings ( n = 6) contributed to more in-depth explanations for findings. The methods used have potential to contribute to understanding of core mechanisms of behavioral-change interventions.

The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration

2020 ◽  
Vol 163 (2) ◽  
pp. 232-243 ◽  
Author(s):  
Rebecca L. Cherney ◽  
Vinciya Pandian ◽  
Ashly Ninan ◽  
Debra Eastman ◽  
Brian Barnes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Care Pathway ◽  
Interdisciplinary Collaboration ◽  
Unit Length ◽  
Control Group ◽  
Staff Nurse ◽  
Prospective Comparison

Objective To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Results Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 ( P < .05). The incidence of adverse events was unchanged. Discussion Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

On Small Solute Clearance and Patient Outcomes: Evidential Practice or Observational Trepidation?

2009 ◽  
Vol 29 (6) ◽  
pp. 623-629 ◽  
Author(s):  
Edward Vonesh
Keyword(s):  
Patient Outcomes ◽  
Observational Studies ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Dialysis Adequacy ◽  
Risk Of Death ◽  
Randomized Controlled ◽  
Anzdata Registry ◽  
Small Solute ◽  
Solute Clearance

Recent guidelines on peritoneal dialysis adequacy set a minimum target for small solute clearance at Kt/V urea 1.70. While evidence from both observational studies and randomized controlled trials (RCTs) supports such a minimum target, there continues to be debate over what role small solute clearance plays in determining patient outcome. Current ANZDATA Registry results from Australia and New Zealand add fuel to this debate by demonstrating a significant nonlinear U-shaped relationship between peritoneal small solute clearance and patient survival. The ANZDATA results indicate that patients with too low or too high peritoneal Kt/V urea may be at significant risk of death compared to those with a peritoneal Kt/V urea between 1.70 and 2.00. As these results are somewhat at odds with results from published RCTs, we will examine the level of evidence from the observational setting that is the ANZDATA Registry and contrast it against the level of evidence from RCTs, particularly the ADEMEX trial. New results from the ADEMEX study are presented as a possible explanation for the paradoxical U-shaped results seen in the ANZDATA study.

EFFECTIVENESS AND LIMITATIONS OF AN EARLY DISCHARGE CARE PATHWAY FOR TRANS-CATHETER AORTIC VALVE RECIPIENTS IN A MODERATE VOLUME CENTRE.

2018 ◽  
Vol 34 (10) ◽  
pp. S126-S127
Author(s):  
B. Adjibodu ◽  
A. Mukumbola kasongo ◽  
J. Potvin ◽  
F. Gobeil ◽  
J. Forcillo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Care Pathway ◽  
Early Discharge ◽  
Discharge Care ◽  
Moderate Volume

scholarly journals Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review

2017 ◽  
Vol 52 (9) ◽  
pp. 607-616 ◽  
Author(s):  
Drayton A. Hammond ◽  
Jordan M. Rowe ◽  
Adrian Wong ◽  
Tessa L. Wiley ◽  
Kristen C. Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Alcohol Withdrawal Syndrome ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Icu Admission

Purpose: Benzodiazepines are the drug of choice for alcohol withdrawal syndrome (AWS); however, phenobarbital is an alternative agent used with or without concomitant benzodiazepine therapy. In this systematic review, we evaluate patient outcomes with phenobarbital for AWS. Methods: Medline, Cochrane Library, and Scopus were searched from 1950 through February 2017 for controlled trials and observational studies using [“phenobarbital” or “barbiturate”] and [“alcohol withdrawal” or “delirium tremens.”] Risk of bias was assessed using tools recommended by National Heart, Lung, and Blood Institute. Results: From 294 nonduplicative articles, 4 controlled trials and 5 observational studies (n = 720) for AWS of any severity were included. Studies were of good quality (n = 2), fair (n = 4), and poor (n = 3). In 6 studies describing phenobarbital without concomitant benzodiazepine therapy, phenobarbital decreased AWS symptoms ( P < .00001) and displayed similar rates of treatment failure versus comparator therapies (38% vs 29%). A study with 2 cohorts showed similar rates of intensive care unit (ICU) admission (phenobarbital: 16% and 9% vs benzodiazepine: 14%) and hospital length of stay (phenobarbital: 5.85 and 5.30 days vs benzodiazepine: 6.64 days). In 4 studies describing phenobarbital with concomitant benzodiazepine therapy, phenobarbital groups had similar ICU admission rates (8% vs 25%), decreased mechanical ventilation (21.9% vs 47.3%), decreased benzodiazepine requirements by 50% to 90%, and similar ICU and hospital lengths of stay and AWS symptom resolution versus comparator groups. Adverse effects with phenobarbital, including dizziness and drowsiness, rarely occurred. Conclusion: Phenobarbital, with or without concomitant benzodiazepines, may provide similar or improved outcomes when compared with alternative therapies, including benzodiazepines alone.

Issues Regarding Aggregation of Data in Nursing Systems Research

1994 ◽  
Vol 2 (1) ◽  
pp. 79-101 ◽  
Author(s):  
Linda C. Hughes ◽  
Ruth A. Anderson
Keyword(s):  
Patient Outcomes ◽  
Outcomes Research ◽  
Organizational Context ◽  
Nursing Intervention ◽  
Group Level ◽  
Skilled Nursing ◽  
Aggregated Data ◽  
Nursing Unit ◽  
Systems Research ◽  
Using Data

The unit of analysis at which variables are conceptualized and measured is an important consideration when conducting patient outcomes research. Outcomes research ranges from study of individual responses to nursing intervention to investigation of group level outcomes associated with the contexts and processes through which nursing care is delivered. Because many variables salient to the investigation of group level patient outcomes are not amenable to direct measurement, aggregation procedures are used to generate proxy measurement of organizational context or process variables. In this article, key conceptual and methodologic issues encountered when using data aggregation procedures are reviewed. Following this, estimation of aggregated data reliability is illustrated using data from a study conducted to investigate skilled nursing unit structures.

Haul-out behaviour of two Ross seals off eastern Antarctica

2003 ◽  
Vol 15 (2) ◽  
pp. 257-258 ◽  
Author(s):  
COLIN SOUTHWELL
Keyword(s):  
Observational Data ◽  
Observational Studies ◽  
The Other ◽  
Accurate Assessment ◽  
Limited Information ◽  
Absolute Sense ◽  
Crabeater Seal ◽  
Abundance Estimates ◽  
Antarctic Seals ◽  
Using Data

Accurate assessment of the abundance of pinnipeds from visual surveys requires estimation of both the available (hauled-out) and unavailable (in-water) components of the population (Eberhardt et al. 1979). Continental estimates of the abundance of the four Antarctic seals are based on limited information on haul-out behaviour. In developing continental estimates, Erickson & Hanson (1990) corrected visual surveys of the hauled-out component of the species' populations using data from observational studies of haulout behaviour by Erickson et al. (1989). Erickson & Hanson (1990) point out that, because the observational studies did not account for an unknown fraction of seals that remained in the water during the peak haul-out period, their abundance estimates are minimum values. Further, Erickson & Hanson (1990) corrected the visual surveys for all four species using haul-out data for the crabeater seal only, as observational data for the other species were not available. This assumes that haul-out patterns are constant across species, which is largely untested. Consequently, there is potential for bias, in both a relative and absolute sense, in the estimated abundance of Antarctic seals.

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